Publisher Health

For decades, the university required students seeking medical leaves to withdraw and reapply. A campus suicide set off a cascade of revisions.In the weeks after Rachael Shaw-Rosenbaum, a first-year student at Yale, died by suicide in 2021, a group of strangers began convening on Zoom.Some of them knew Ms. Shaw-Rosenbaum. But many only knew what she had been going through, as she struggled with suicidal thoughts and weighed the consequences of checking herself into the hospital.One, a physician in her early 40s, had been told years ago to withdraw from Yale while she was hospitalized after a suicide attempt, an experience she recalls as chillingly impersonal, “like you’re being processed through this big machine.”Another, a classical pianist in his 20s, withdrew from Yale amid episodes of hypomania and depression, feeling, as he put it, “not just excluded but rejected and cut off and forgotten about.”Members of the group, which took the name Elis for Rachael, shared a complaint that Yale’s strict policies on mental health leaves — requiring students to withdraw without a guarantee of readmission, stripping them of health insurance and excluding them from campus — had penalized students at their most vulnerable moments.“We discovered that there were just generations of Yalies who had had similar issues, who had kept quiet about it for decades and decades,” said Dr. Alicia Floyd, the physician, one of the group’s founders. “And we all felt like something needed to change.”The organizing that began that day culminated last month in a legal settlement that considerably eases the process of taking a medical leave of absence at Yale.Under the new policy, students will have the option to extend their insurance coverage for a year. They will no longer be banned from campus spaces or lose their campus jobs. Returning from leave will be simpler, with weight given to the opinion of the student’s health care provider.Most strikingly, Yale has agreed to offer part-time study as an accommodation for students in some medical emergencies, a step it had resisted.“My hope is that the changes that have emerged from these discussions will make it easier for students to ask for support, focus on their health and well-being and take time off if they wish, knowing that they can resume their studies when they are ready,” said Pericles Lewis, the dean of Yale College, in a message to students.Yale declined to comment beyond the statement from Dean Lewis.Yale’s withdrawal policies were the subject of a Washington Post investigation in November 2022. The same month, Elis for Rachael filed a class-action lawsuit accusing the university of discriminating against students with disabilities.Yale is not the only elite university to face legal challenges over its mental health policies. The Department of Justice has investigated Brown and Princeton over their handling of withdrawals, and Stanford faced a similar class-action lawsuit in 2019.By offering part-time study as an accommodation, Yale has provided relief beyond what Stanford did, said Monica Porter Gilbert, an attorney at the Bazelon Center for Mental Health Law who represented plaintiffs in both cases.“It’s the students and the plaintiffs in this case making their voices heard and bringing Yale to the table to have difficult conversations,” she said. The pandemic years, she added, have brought new urgency to their arguments. “As a nation, we talk about mental health differently now.”Alicia Abramson, a Yale senior who is one of the two student plaintiffs in the class-action lawsuit, said Yale’s response was swifter and more comprehensive than she had expected. “It’s hopeful, in the sense that maybe they are finally taking this thing seriously,” she said.She has no plans to abandon her advocacy work anytime soon, though. “I’m certainly hesitant to give Yale infinite praise,” she said. “You know, we had to sue them, right?”A Campus ShakenRachael Shaw-Rosenbaum, who died in 2021.As she struggled with suicidal thoughts in the second half of her first year at Yale, Ms. Shaw-Rosenbaum worried she would be forced to withdraw, jeopardizing the scholarships she needed to stay at Yale, said Zack Dugue, her boyfriend.She had already been hospitalized once, her first semester. “Basically, if I go to the hospital again, I will not be able to resume college and will lose the opportunity I had to learn at an extremely competitive university,” she wrote in a post on Reddit a few days before she died.Growing up in Anchorage, Alaska, Ms. Shaw-Rosenbaum had been a debate champion. She dreamed of following her idol, Ruth Bader Ginsburg, to the Supreme Court.Mr. Dugue, who met her at a scholarship event the spring of their senior year of high school, described her as “a tiny firebrand” and “super-duper kind.” She was still very young: Mr. Dugue was the first boy she ever kissed, her mother said. She was not from a wealthy family; at home, she had at one time received health care through Medicaid. Withdrawing would mean losing not just her sense of belonging, but her Yale health insurance, a prospect Mr. Dugue said she found “apocalyptic.”“She also would have lost access to the very care she needed,” he said. “That was like a terrible tightrope to walk.”For decades, students had criticized Yale’s withdrawal and readmission policies, which were deemed among the least supportive in the Ivy League in a 2018 white paper by the Ruderman Family Foundation.In 2015, a sophomore math major named Luchang Wang died by suicide after posting a desperate message on Facebook, saying she “couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted.”“Yale was a case where they were being very strict, and people would have to apply multiple times,” said Marcus Hotaling, president of the Association for University and College Counseling Center Directors and director of counseling at Union College in Schenectady, N.Y.Colleges must weigh the risks of allowing struggling students to remain on campus, he said, since they may be found liable for allowing a student’s condition to deteriorate.Dr. Hotaling cited the case of Elizabeth Shin, a student at the Massachusetts Institute of Technology who died by suicide in 2000. Her parents, who had not been told of her decline, filed a $27 million wrongful death lawsuit against M.I.T.; the case was settled for an undisclosed amount.Suicide contagion may be a concern for the university; so is the effect a suicide on campus may have on the larger community. “That’s going to have a drastic impact on the roommate, on the residents who live around them, their friends, their peers, their classmates,” he said.After Ms. Shaw-Rosenbaum’s death, Yale officials took the unusual step of releasing a statement denying an allegation, circulating on social media, that Yale had refused her request to take a leave.Undergraduate activists began demanding changes to the leave policy, as they had after previous suicides, but there was little response from Yale. “At the end of the day, we recognized we were at the mercy of the institution,” said Miriam Kopyto, who was then a leader in the Yale Student Mental Health Association.A shift came with the involvement of alumni, who convened their first Zoom meeting just a few days after Ms. Shaw-Rosenbaum’s death. About two dozen people attended, including Mr. Dugue, and all felt some personal connection to the cause, said Lily Colby, a community organizer.They held a moment of silence, shared pictures of Ms. Shaw-Rosenbaum and told their own stories. “We have been impacted in some way,” Ms. Colby said later, describing the core group. “We’ve had a loss or a tragedy.”Students had tended to ask the university for accommodations on the grounds that it was the right thing to do, Ms. Colby said. The alumni began educating them on what they could demand under law — like a change to the leave policies.For student activists, this was a fundamental shift. “Some of it is a favor,” Ms. Kopyto said. “And some of it is not.”‘Time Away Mentors’Lucy Kim was among the last undergraduates to take a medical withdrawal under the old system. She had to re-apply for admission back into the university after her withdrawal.Joe Buglewicz for The New York TimesIn January, Yale introduced major changes to its policy, reclassifying mental health breaks as leaves of absence rather than withdrawals, extending health insurance benefits and simplifying the reinstatement policy.The settlement expands those protections by offering part-time study and creating a “Time Away Resource” for undergraduates. The court will oversee Yale’s compliance with the agreement for three years.Lucy Kim, 22, who was among the last undergraduates to take a medical withdrawal under the old system, recalls crying when she read the news, because the accommodations were the ones that she had needed.“I just kept thinking, if only I had gotten sick a year later,” she said.She was a second-semester sophomore, juggling coursework in molecular biology and biochemistry and global affairs, when she stopped sleeping for 40-hour stretches. Her hands shook so violently that she dropped things. She began hallucinating.Diagnosed with a sleep disorder, she initiated a medical withdrawal in December 2021. She had studied the policies, but was still jolted by the reality: She was given 72 hours to vacate her dormitory and surrender her key card.“It really is like losing your house, your job and your family, all at the same time,” she said. She drained her savings, she said, spending $15,000 on rent, food and tuition for summer school classes before applying for reinstatement by submitting an essay, grades and letters of recommendation.Ms. Kim, who will graduate next May, hopes mental health leaves will be seen differently now. This weekend, she began recruiting undergraduates to serve as “time away mentors” who help others navigate the process of taking leaves and returning to campus. She hopes that the university will provide funding.“I think that Yale does want to move in the right direction,” she said. “It’s a matter of accumulating those voices for change until it reaches the threshold point where Yale says this is probably for the benefit of the greater student body.”In interviews, students said the new policy opens avenues they had viewed as shut.“What they’ve done has created an opening where I feel like I could actually go back if I wanted to,” said one former student, Jen Frantz, referring to the option of part-time study. She withdrew from Yale twice because of mental health crises, and finally let go of the idea of finishing her degree.Ms. Frantz, 26, went on to get an M.F.A. in poetry at the Iowa Writers’ Workshop and now tutors students working on college essays. She said she felt “a little light touch of mourning of what could have been if they had been more prompt.”As for Ms. Shaw-Rosenbaum, she was a stickler for detail. Had she lived, Mr. Dugue said, she might have sued Yale herself at some point.“She read the withdrawal policies, she explained them to me, she was thinking about them, she knew they were wrong,” he said.Rachael’s mother, Pamela Shaw, singled out two provisions of the settlement that she thought would have helped her daughter: part-time study and an administrator dedicated to advising on time away.“I just wish she’d been here for the fight,” Ms. Shaw said.Kitty Bennett, Susan Beachy and Alain Delaquérière contributed research.

When we determine which communities are more likely to get their water from contaminated supplies, median household income is not the best measure.
That’s according to a recent study led by researchers at The University of Texas at Austin that found social factors — such as low population density, high housing vacancy, disability and race — can have a stronger influence than median household income on whether a community’s municipal water supply is more likely to have health-based water-quality violations. In general, rural communities and communities that grew up around large industries that have since left are most likely to face water-quality issues.
About 10% of community water systems in the contiguous United States have a reported health-based violation. The study’s findings are important because many state and federal agencies use median household income as the primary factor when deciding how to distribute funding meant to assist disadvantaged communities.
“As states are developing definitions and trying to prioritize disadvantaged communities, they should look at a number of different parameters and see which ones apply best for them,” said lead author Bridget Scanlon, a senior research scientist at the UT Bureau of Economic Geology. “The study offers a useful tool that lawmakers can use to learn more about how different types of social vulnerability are associated with different water-quality issues. This can then aid in coming up with lasting solutions that community water systems need to fix these issues.”
The study was published in Environmental Research Letters.
Scanlon and her collaborators were inspired to look into the connection between social vulnerability and water-quality violations due to the passage of new federal drinking water infrastructure laws. The new laws require states to allocate at least 49% of about $50 billion in federal funding to address water issues in disadvantaged communities.
But which communities are considered disadvantaged is often left up to state policymakers to decide, with most states opting to use median household income as the primary (or the only) factor, according to the study
The researchers tested how well median income matched up with water-quality violations reported during 2018-2020 in community water systems across the contiguous United States. It then compared the results with those from a new social vulnerability index created for the study that took 15 social factors into account. The study’s social index is modified from a similar index created by the Centers for Disease Control and Prevention that’s used for identifying communities that may need more support during natural disasters and public health emergencies.

The fashion photographer disclosed her health challenges in an interview with The Wall Street Journal Magazine.Linda Evangelista, the supermodel made famous in the 1990s, revealed in an interview that she survived breast cancer twice in five years.The fashion photographer described her diagnoses and multiple health challenges in an interview with The Wall Street Journal Magazine that was published on Tuesday.Ms. Evangelista, 58, said she was first diagnosed in 2018 after an annual mammogram. The magazine noted that it was the first time she had spoken publicly about her cancer.Ms. Evangelista did not immediately respond for comment on Tuesday.In response to her diagnosis, she said, she chose to undergo a bilateral mastectomy, “thinking I was good and set for life. Breast cancer was not going to kill me.”However, four years later, in 2022, she learned that the cancer had returned, this time in her pectoral muscle.She recalled telling her surgeon, “Dig a hole in my chest.”“I don’t want it to look pretty. I want you to excavate. I want to see a hole in my chest when you’re done,” she had said to her doctors. “Do you understand me? I’m not dying from this.”After a second surgical procedure, Ms. Evangelista in the interview described her current prognosis as “good,” as told by her post-cancer care oncologist.However, she said, her doctor had given her a “horrible oncotype score,” a number that represents the risk of cancer recurrence.Still, she said, the uncertainty has made her days more valuable.“I know I have one foot in the grave, but I’m totally in celebration mode,” she said.Breast cancer diagnoses have not been the only health issues for Ms. Evangelista in recent years.Two years ago in an Instagram post, she revealed that side effects from CoolSculpting, a “fat-freezing” procedure, had left her “permanently deformed” and “brutally disfigured” as she had developed paradoxical adipose hyperplasia, an effect in which firm tissue masses develop in the treatment areas.The condition, she said, caused her to become depressed and reclusive after “not looking like myself any longer.”She subsequently sued Zeltiq Aesthetics, the company behind the procedure, for $50 million and settled in July 2022 for an undisclosed amount. Ms. Evangelista was one of the top five supermodels in the world in the 1990s, and she has continued to work and has stepped back into the spotlight since her CoolSculpting procedures and side effects.In 2022, she appeared on the cover of British Vogue, and beginning on Sept. 20, she will appear in a new Apple TV+ documentary, “The Super Models.” The project will reunite her with other 90s-era supermodels including Christy Turlington, Naomi Campbell and Cindy Crawford. In 1990, the four women famously appeared lip-syncing the lyrics in the George Michael video, “Freedom 90.”

Researchers have discovered a new avenue of cell death in Alzheimer’s disease and vascular dementia.
A new study, led by scientists at Oregon Health & Science University and published online in the journal Annals of Neurology on Aug. 21, reveals for the first time that a form of cell death known as ferroptosis — caused by a buildup of iron in cells — destroys microglia cells, a type of cell involved in the brain’s immune response, in cases of Alzheimer’s and vascular dementia.
The researchers conducted the study examining post-mortem human brain tissue of patients with dementia.
“This is a major finding,” said senior author Stephen Back, M.D., Ph.D., a neuroscientist and professor of pediatrics in the OHSU School of Medicine.
Back has long studied myelin, the insulation-like protective sheath covering nerve fibers in the brain, including delays in forming myelin in premature infants. The new research extends that line of work by uncovering a cascading form of neurodegeneration triggered by deterioration of myelin. They made the discovery using a novel technique developed by the study’s lead author Philip Adeniyi, Ph.D., a postdoctoral researcher in Back’s laboratory.
The researchers discovered that microglia degenerates in the white matter of the brain of patients with Alzheimer’s and vascular dementia.
Microglia are resident cells in the brain normally involved in clearing cellular debris as part of the body’s immune system. When myelin is damaged, microglia swarm in to clear the debris. In the new study, researchers found that microglia themselves are destroyed by the act of clearing iron-rich myelin — a form of cell death known as ferroptosis.

Plant-based alternatives such as tempeh and bean burgers provide protein-rich options for those who want to reduce their meat consumption. However, replicating meat’s flavors and aromas has proven challenging, with companies often relying on synthetic additives. A recent study in ACS’ Journal of Agricultural and Food Chemistry unveils a potential solution: onions, chives and leeks that produce natural chemicals akin to the savory scents of meat when fermented with common fungi.
When food producers want to make plant-based meat alternatives taste meatier, they often add precursor ingredients found in meats that transform into flavor agents during cooking. Or, the flavoring is prepared first by heating flavor precursors, or by other chemical manipulations, and then added to products. Because these flavorings are made through synthetic processes, many countries won’t allow food makers to label them as “natural.” Accessing a plant-based, “natural” meat flavoring would require the flavoring chemicals to be physically extracted from plants or generated biochemically with enzymes, bacteria or fungi. So, YanYan Zhang and colleagues wanted to see if fungi known to produce meaty flavors and odors from synthetic sources could be used to create the same chemicals from vegetables or spices.
The team fermented various fungal species with a range of foods and found that meaty aromas were only generated from foods in the Allium family, such as onions and leeks. The most strongly scented sample came from an 18-hour-long fermentation of onion using the fungus Polyporus umbellatus, which produced a fatty and meaty scent similar to liver sausage. With gas chromatography-mass spectrometry, the researchers analyzed the onion ferments to identify flavor and odor chemicals, and found many that are known to be responsible for different flavors in meats. One chemical they identified was bis(2-methyl-3-furyl) disulfide, a potent odorant in meaty and savory foods. The team says that alliums’ high sulfur content contributes to their ability to yield meat-flavored compounds, which also often contain sulfur. These onion ferments could someday be used as a natural flavoring in various plant-based meat alternatives, the researchers say.

An essential protein that acts as a gatekeeper for calcium entering cells promotes the growth of oral cancer and generates pain, according to a new study published in Science Signaling led by researchers at NYU College of Dentistry.
Targeting this protein — the ORAI1 calcium channel — could provide a new approach to treating oral cancer, which causes persistent pain that worsens as it progresses.
“Our results show that the ORAI1 channel fuels the growth of oral cancer tumors and produces an abundance of molecules that, once secreted, interact with neurons resulting in an increased sensitivity to pain,” said Ga-Yeon Son, a postdoctoral fellow in the Department of Molecular Pathobiology at NYU College of Dentistry and the study’s first author.
The keepers of the gates of heaven
ORAI calcium channels — named after the three sisters in Greek mythology who guarded the gates of heaven at Mount Olympus — play an important role controlling how much calcium enters cells.
“These calcium channels can be a source of good or bad for cells,” said Rodrigo Lacruz, professor of molecular pathobiology at NYU College of Dentistry and the study’s senior author.
“Calcium entering cells is necessary for many good things, but too much calcium for a long time has the opposite effect.”
Calcium channels have been linked to various cancers, especially cancer progression, but few studies have looked at the role of ORAI1 in cancer and pain.

If the region surrounding Chicago — North America’s largest freight hub — shifted just 30% of its current on-road heavy-duty vehicles to electric versions, it would substantially reduce pollution and save hundreds of lives per year, with the benefits largely concentrated in disadvantaged communities, according to a new Northwestern University-led study. The study authors highlight that neighborhoods with predominantly Black, Hispanic and Latinx residents would benefit the most — potentially reducing disproportionate pollution and health burdens in historically marginalized areas
The study authors highlight that neighborhoods with predominantly Black, Hispanic and Latinx residents would benefit the most — potentially reducing disproportionate pollution and health burdens in historically marginalized areas.
Although the study specifically focuses on the lower Great Lakes region (including Chicago, Milwaukee and Grand Rapids, Michigan), these findings hint that electrifying heavy-duty vehicles across the nation could help reduce long-standing environmental injustices related to pollutant impact disparities in major metropolitan areas.
The study will be published today (Sept. 5) in the journal Nature Sustainability.
“Heavy-duty vehicles only constitute a small portion of the total on-road vehicle fleet — about 6% — but they disproportionately contribute to the emission and/or creation of health-harming air pollutants and greenhouse gases,” said Northwestern’s Sara Camilleri, who led the study. “In fact, the heavy-duty vehicle sector is the largest contributor to on-road nitrogen oxides and second largest source of on-road carbon dioxide emissions. Targeting this small portion of vehicles could have outsized implications for emission reductions.”
“When designing policies, optimizing beneficial impacts is ideal,” added Northwestern’s Daniel Horton, the study’s senior author. “Of course, incentivizing the electrification of passenger vehicles is important given their sheer numbers. But, from an impact perspective, our study suggests that it also makes sense to incentivize transitioning fossil fuel-powered heavy-duty vehicles to electric vehicles because they have such negative consequences for the climate and for human health, particularly in disadvantaged communities.”
Horton is an assistant professor of Earth and planetary sciences at Northwestern’s Weinberg College of Arts and Sciences, where he directs the Climate Change Research Group. Camilleri is a postdoctoral scholar in Horton’s laboratory.

New research from Tulane University may shed light on how parasite strain diversity can impact Chagas disease progression and severity.
Chagas, a lesser-known and studied tropical disease, is caused by Trypanosoma cruzi parasites, which are transmitted by kissing bugs. In the Americas, the disease affects 6 million people in 21 countries, with approximately 30,000 new cases each year. While most infected patients remain asymptomatic, about 20-40 percent of those infected will develop chronic heart disease years or decades after infection, and about 5 percent will develop digestive disease. Treating Chagas patients is challenging because the disease progression is unpredictable, resulting in 14,000 deaths annually..
In a new study published in Microbiology Spectrum, Tulane researchers were able to establish a link between disease progression and parasite strain diversity. Rhesus macaques naturally infected with T. cruzi were studied for two to three years, and researchers found that those infected with mixtures of multiple strains were able to better control the parasite and stop the progression of the disease, while those with a progressive form of the disease had fewer strains.
“Since the 1980s, researchers have proposed that different strains could be associated with different disease outcomes due to the parasite’s genetic diversity, but decades of research failed to uncover clear associations,” said lead study author Eric Dumonteil, PhD, associate professor of tropical medicine at Tulane University School of Public Health and Tropical Medicine. “In finding a clear association, these results provide a new framework for the development of more effective treatments and vaccines.”
Dumonteil said studies are ongoing to further understand the interactions of various parasite strains during infection.
The study was co-authored by Dumonteil, Hans Desale, PhD, Claudia Herrera, PhDand Preston Marx, PhD, from the Department of Tropical Medicine. The research was conducted at the Tulane National Primate Research Center. Technical support was provided by medical research specialist Kelly Goff, Monica Shroyer and Weihong Tu. Nora Hernandez-Cuevas from the Autonomous University of Yucatan in Mexico collaborated in the study.

Indoor air pollution generated by cooking fuels such as charcoal and wood causes approximately four million premature deaths every year — a tragic statistic that Surrey’s Global Centre for Clean Air Research (GCARE) is aiming to address with its Kitchen Pollution Guidance.
This comprehensive guidance is led by Professor Prashant Kumar and a team of over 50 co-authors from 20 countries. This guidance presents scientific research on practical measures that are easy to implement. It offers helpful tips and actionable advice for individuals while also suggesting actions that housing providers and governing bodies can take.
Professor Prashant Kumar, Founding Director of GCARE, said:
“We all take clean air for granted, particularly when we are in the kitchen — a room that is central in many people’s homes across the world. Our guidance is now available in 17 different languages, a fact that demonstrates that we are passionate about passing on this knowledge to as many people as possible.”
The guidance provides several targeted recommendations for ordinary citizens, housebuilders, and policymakers. Key recommendations for ordinary citizens include: Reduce the number of meals you fry in the kitchen. Steer towards shorter cooking sessions. Keep children (and other people who are not preparing a meal) out of the kitchen. Open kitchen windows during cooking to reduce carbon dioxide.GCARE’s kitchen guidance has recently been adopted and promoted by the Egyptian government.
Dr Yasmin Fouad from Egypt’s Ministry of the Environment said:
“We are working to support all procedures and good practices to avoid the negative effects of emissions that cause environmental air pollution both indoor and ambient.”

Bioelectrical impedance analysis is a method used for estimating body composition. This method estimates body composition based on the degree of current flow in the body, allowing noninvasive and rapid measurement, and is used in home-use body composition monitors and other devices. However, existing estimation methods might not be sufficient for accurately assessing skeletal muscle mass in individuals such as athletes and active men, whose muscle quality and composition differ from those of the general adult population.
In this study, researchers from the University of Tsukuba evaluated the validity of bioelectrical impedance for estimating skeletal muscle mass specifically in athletes and active men. Results revealed a strong correlation between skeletal muscle mass and bioelectrical impedance indices, confirming that bioelectrical impedance is a useful tool for this purpose.
In addition, bioelectrical impedance is effective for estimating intracellular water levels. This finding is likely to encourage broader adoption of bioelectrical impedance for body composition assessments in medical institutions and fitness facilities, making evaluations easier and more accurate. In the future, researchers anticipate the development of more precise estimation formulas, which will facilitate the evaluation of the effectiveness of training and nutritional interventions for athletes. Moreover, the adaptability of these new formulas for diverse populations will be further investigated.
This work was supported by the JSPS KAKENHI for HS (16J11877and 20K19563), HT (19H04017), YY (18H03164), the University of Tsukuba Advanced Research Initiative for Human High Performance (ARIHHP), and Casio Science Pro-motion Foundation.